Between Care and Control: Examining Surveillance Practices in Harm Reduction

As harm reduction programs and services proliferate, people who use drugs (PWUD) are increasingly subjected to surveillance through the collection of their personal information, systematic observation, and other means. The data generated from these practices are frequently repurposed across various institutional sites for clinical, evaluative, epidemiological, and administrative uses. Rationales provided for increased surveillance include the more effective provision of care, service optimization, risk stratification, and efficiency in resource allocation. With this in mind, our reflective essay draws on empirical analysis of work within harm reduction services and movements to reflect critically on the impacts and implications of surveillance expansion. While we argue that many surveillance practices are not inherently problematic or harmful, the unchecked expansion of surveillance under a banner of health and harm reduction may contribute to decreased uptake of services, rationing and conditionalities tied to service access, the potential deepening of health disparities amongst some PWUD, and an overlay of health and criminal-legal systems. In this context, surveillance relies on the enlistment of a range of therapeutic actors and reflects the permeable boundary between care and control. We thus call for a broader critical dialogue within harm reduction on the problems and potential impacts posed by surveillance in service settings, the end to data sharing of health information with law enforcement and other criminal legal actors, and deference to the stated need among PWUD for meaningful anonymity when accessing harm reduction and health services.

The group-based law enforcement mistrust scale: psychometric properties of an adapted scale and implications for public health and harm reduction research

Background

Negative encounters with law enforcement—direct and vicarious—fuel mistrust. When considered as part of the ‘risk environment’ in public health and harm reduction research, law enforcement mistrust may have broad implications. For example, fearing arrest may prevent someone from calling 911 when witnessing an overdose or lead to syringe-sharing and community spread of HIV. For people in the US who identify as Black or African American, these effects may compound, given the ways in which communities of color have been overpoliced. The purpose of this study is to investigate the psychometrics of an adapted scale of law enforcement mistrust—the Group-Based Law Enforcement Mistrust Scale (GBLEMS)—and evaluate its associations with racial and ethnic identity and experiences with law enforcement.

Methods

This cross-sectional survey took place in a small city in the Western United States where only 3% of the population is Black or African American. The sample included Black or African American and Hispanic and Latina women at risk of HIV, and members of their social networks, yielding a diverse sample across racial, ethnic, and gender identities (N = 219). The GBLEMS is a 12-item scale adapted from the Group-Based Medical Mistrust Scale (GBMMS; Thompson et al. 2004). The current analysis evaluated the psychometric properties of the GBLEMS (reliability, exploratory factor analysis) and its associations with demographics, other race-based constructs, and experiences with law enforcement.

Results

The GBLEMS demonstrated strong reliability (Cronbach’s alpha = 0.92) and exploratory factor analysis indicated that items loaded onto two factors—mistrust and disparities in treatment. There was also support for the scale’s construct validity. As hypothesized, GBLEMS scores were higher among respondents who identify as Black or African American, and among those who reported other experiences of racial discrimination, medical mistrust, and negative encounters with law enforcement.

Conclusions

This study yielded support for the reliability and validity of the GBLEMS as a multi-item, two-factor scale measuring group-based law enforcement mistrust. When framing public health and harm reduction research in terms of the risk environment, law enforcement mistrust may be important to measure as part of a comprehensive approach that addresses persistent racial disparities.

Diverting people who use drugs from the criminal justice system: A systematic review of police-based diversion measures

BACKGROUND

Previous reviews of the effectiveness of measures to divert those who use drugs from the criminal justice system have focused mainly on post-conviction or post-sentence programs and report mixed results. The present systematic review synthesizes evidence on the effectiveness of police-based diversion measures in reducing criminal offenses and other harms related to drug use and then summarizes evidence from qualitative studies to identify facilitators and barriers associated with the implementation of such measures.

METHODS

Eight databases were searched to find evaluations of police-based diversion measures for drug-related offenders. Twenty-seven studies were identified. The vote-count method and the Maryland Scientific Method Scale were used to assess the impact of police-based diversion measures. Themes related to barriers or conditions facilitating the implementation of these measures were extracted from qualitative studies.

RESULTS

Evidence from quantitative studies indicates that in general police-based diversion measures are effective in preventing criminal offending and show promising results for improving participants' health and diminishing social costs as well as costs associated with processing drug-related offenses. There was insufficient evidence to draw conclusions about the effect of police-based diversion measures on drug use, drug accessibility, or changes in participants' socioeconomic conditions. Findings from qualitative studies suggest that program acceptance by police officers, constructive intersectoral collaboration, clear eligibility criteria, and timely access to services seem to facilitate the implementation and delivery of police-based diversion measures.

CONCLUSION

Police-based diversion measures can be effective in preventing drug-related criminal offenses and harm. Additional research is needed to evaluate their effect on participants' socioeconomic conditions and drug use as well as drug accessibility.

Moving Beyond Narcan: A Police, Social Service, and Researcher Collaborative Response to the Opioid Crisis

The opioid crisis is the most persistent, long-term public health emergency facing the United States, and available evidence suggests the crisis has worsened during the COVID-19 global pandemic. Naloxone is an effective overdose response that saves lives, but the drug does not address problematic drug use, addiction, or the underlying conditions that lead to overdoses. The opioid crisis is at its core a multidisciplinary, multisystem problem, and an effective response to the crisis requires collaboration across those various systems. This paper describes such a collaborative effort. The Tempe First-Responder Opioid Recovery Project is a multidisciplinary partnership that includes police officers, social workers, substance use peer counselors, public health professionals, police researchers, and drug policy/harm reduction researchers. The project, 10 months underway, trained and equipped Tempe (AZ) police officers to administer Narcan. In addition, a 24/7 in-person "Crisis Outreach Response Team" rapidly responds to any suspected overdose and offers follow-up support, referrals, and services to the individual (and loved ones) for up to 45 days after the overdose. We present preliminary project data including interviews with project managers, counselors, and police officers, descriptions of Narcan administrations in the field, and aggregate data on client service engagement. These data highlight the complexity of the opioid crisis, the collaborative nature of the Tempe project, and the importance of initiating a multidisciplinary, comprehensive response to effectively deal with the opioid problem.

An assessment of officer attitudes toward the training and use of a pre-booking diversionary program

The opioid epidemic in the United States has led police departments and other professionals to examine the current approach to drug enforcement. Different law enforcement diversionary programs, centered on public health approaches, have emerged. One such program, the "pre-booking" diversionary program, has been the subject of limited research. The current research assessed officer attitudes toward the training and execution of one such diversionary program in two urban police departments. Results from more than 100 surveys provide officers' perceptions of the training they received and their involvement in the program. We provide their detailed feedback and suggestions for law enforcement, outreach workers, and treatment program personnel in hopes that such diversionary programs will become widespread and effectively utilized in more communities.

"Pick up anything that moves": a qualitative analysis of a police crackdown against people who use drugs in Tijuana, Mexico

BACKGROUND

Homeless people who use drugs (PWUD) are often displaced, detained, and/or forced into drug treatment during police crackdowns. Such operations follow a zero-tolerance approach to law enforcement and have a deleterious impact on the health of PWUD. In Mexico, municipal police officers (MPOs) conducted the largest crackdown documented at the Tijuana River Canal (Tijuana Mejora) to dismantle an open drug market. We analyzed active-duty MPOs' attitudes on the rationale, implementation, and outcomes of the crackdown. We also included the involvement of non-governmental allies in the disguised imprisonment as drug treatment referral and potential legal consequences of having illegally detained PWUD.

METHODS

Between February-June 2016, 20 semi-structured interviews were conducted with MPOs in Tijuana. Interviews were transcribed, translated and coded using a consensus-based approach. Emergent themes, trends and frameworks were analyzed through a hermeneutic grounded theory protocol.

RESULTS

Participants recognized the limitations of Tijuana Mejora in effectively controlling crime and addressing drug treatment solutions. MPOs perceived that the intent of the operation was to displace and detain homeless PWUD, not to assist or rehabilitate them. The police operation was largely justified as a public safety measure to reduce the risk of injury due to flooding, decrease drug consumption among PWUD and protect local tourism from PWUD. Some participants perceived the crackdown as a successful public health and safety measure while others highlighted occupational risks to MPOs and potential human rights violations of PWUD.

CONCLUSIONS

Tijuana Mejora illustrated why public and private actors align in enforcing zero-tolerance drug policy. Perceptions of care are often based on captivity of the diseased, not in health and well-being of PWUD. Officer perceptions shed light on the many limitations of this punitive policing tool in this context. A shift towards evidence-based municipal strategies to address drug use, wherein police are perceived as partners in harm reduction rather than antagonists, is warranted.

Police-initiated diversion for youth to prevent future delinquent behavior: a systematic review

This Campbell systematic review examines the effects police-initiated diversion programs on delinquent behavior, compared to traditional system processing. The review summarizes evidence from nineteen high-quality studies, including 13 randomized controlled trials and six quasi-experimental studies. This review includes studies that evaluated the effects of police-led diversionary practices compared to traditional processing for youth under 18 years of age. We identified a total of 14 manuscripts representing 19 evaluations. Of these 19 evaluations, 13 used randomized controlled designs (random assignment to conditions) and 6 used quasi-experimental designs (no random assignment to conditions). Many of these designs included two or more diversionary conditions compared to a common control (traditional processing) producing 31 treatment-comparison contrasts for analysis. These studies were conducted between 1973 and 2011, inclusively. Most were conducted in the USA (11) with the remaining conducted in Canada (4), Australia (2), and the UK (2). The general pattern of evidence is positive, suggesting that police-led diversion reduces the future delinquent behavior of low-risk youth relative to traditional processing. Assuming a 50 percent reoffending rate for the traditional processing condition, the results suggest a reoffending rate of roughly 44 percent for the diverted youth. This overall benefit of diversion holds for the random assignment studies judged to be free from any obvious risks of bias. No meaningful differences were found across types of diversionary programs. Furthermore, we found no evidence to suggest these findings suffer from publication selection bias.

Plain language summary

Police-led diversion of low-risk youth reduces their future contact with the justice system: Police-led diversion of low-risk youth who come into contact with the justice system is more effective in reducing a youth's future contact with the justice system compared to traditional processing.What is this review about?: Youth misconduct and misbehavior is a normal part of adolescence and that misbehavior sometimes crosses the line from disruptive or problematic to delinquent. Nationally representative surveys of youth in the USA have indicated that minor delinquent behavior is normative, particularly for boys. The normative nature of minor delinquent behavior raises the question of how police should respond to minor delinquent behavior in a way that is corrective, but also avoids involving the youth in the criminal justice system beyond what will be effective in reducing future misbehavior.Police diversion schemes are a collection of strategies police can apply as an alternative to court processing of youth. Diversion as an option is popular among law enforcement officers, as it provides an option between ignoring youth engaged in minor wrongdoing and formally charging such youth with a crime. Police-led diversion has the potential to reduce reoffending by limiting the exposure of low-risk youth to potentially harmful effects of engagement with the criminal justice system.What are the main findings of this review?: This review includes studies that evaluated the effects of police-led diversionary practices compared to traditional processing for youth under 18 years of age. We identified a total of 14 manuscripts representing 19 evaluations. Of these 19 evaluations, 13 used randomized controlled designs (random assignment to conditions) and 6 used quasi-experimental designs (no random assignment to conditions). Many of these designs included two or more diversionary conditions compared to a common control (traditional processing) producing 31 treatment-comparison contrasts for analysis. These studies were conducted between 1973 and 2011, inclusively. Most were conducted in the USA (11) with the remaining conducted in Canada (4), Australia (2), and the UK (2).The general pattern of evidence is positive, suggesting that police-led diversion reduces the future delinquent behavior of low-risk youth relative to traditional processing. Assuming a 50 percent reoffending rate for the traditional processing condition, the results suggest a reoffending rate of roughly 44 percent for the diverted youth. This overall benefit of diversion holds for the random assignment studies judged to be free from any obvious risks of bias. No meaningful differences were found across types of diversionary programs. Furthermore, we found no evidence to suggest these findings suffer from publication selection bias.What do the findings of this review mean?: The findings from this systematic review support the use of police-led diversion for low-risk youth with limited or no prior involvement with the juvenile justice system. Thus, police departments and policy-makers should consider diversionary programs as part of the mix of solutions for addressing youth crime.Many of the studies included in the review were conducted in the 1970s and 1980s. Newer high quality studies are needed to ensure that the findings still hold for contemporary juvenile justice contexts. Additional studies are also needed outside of the USA for this same reason. Finally, we recommend that research explore the usefulness of diversion for low-risk adult offenders.How up-to-date is this review?: The search for eligible studies was completed in January of 2017, so only studies identifiable through January 2017 were included. This Campbell systematic review was published in May 2018.

Executive summary/Abstract

Background: Overly punitive responses to youth misconduct may have the unintended consequence of increasing the likelihood of future delinquency; yet, overly lenient responses may fail to serve as a corrective for the misbehavior. Police diversion schemes are a collection of strategies police can apply as an alternative to court processing of youth. Police-initiated diversion schemes aim to reduce reoffending by steering youth away from deeper penetration into the criminal justice system and by providing an alternative intervention that can help youth address psychosocial development or other needs that contribute to their problem behavior.Objectives: The objective of this review was to synthesize the evidence on the effectiveness of pre-court interventions involving police warning or counseling and release, and cautioning schemes in reducing delinquent behavior.Search methods: A combination of 26 databases and websites were searched. References of relevant reviews were also scanned to identify studies. We also consulted with experts in the field. Searches were executed by two reviewers and conducted between August 2016 and January 2017.Selection criteria: Only experimental and quasi-experimental designs were eligible for this review. All quasi-experimental designs must have had a comparison group similar to the police diversion intervention group with respect to demographic characteristics and prior involvement in delinquent behavior (i.e., at similar risk for future delinquent behavior). Additionally, studies must have included youth participants between 12 and 17 years of age who either underwent traditional system processing or were diverted from court processing through a police-led diversion program. Studies were also eligible if delinquency-related outcomes, including official and non-official (self-report or third-party reporting) measures of delinquency were reported.Data collection and analysis: This study used meta-analysis to synthesize results across studies. This method involved systematic coding of study features and conversion of study findings into effect sizes reflecting the direction and magnitude of any police-led diversion effect. There were 19 independent evaluations across the 14 primary documents coded for this review. From this, we coded 67 effect sizes of delinquent behavior post diversion across 31 diversion-traditional processing comparisons. We analyzed these comparisons using two approaches. The first approach selected a single effect size per comparison based on a decision rule and the second used all 67 effect sizes, nesting these within comparison condition and evaluation design.Results: The general pattern of evidence is positive, suggesting that police-led diversion modestly reduces future delinquent behavior of low-risk youth relative to traditional processing.Authors' conclusions: The findings from this systematic review support the use of police-led diversion for low-risk youth with limited or no prior involvement with the juvenile justice system. Thus, police departments and policy-makers should consider diversionary programs as part of the mix of solutions for addressing youth crime.

Seattle's Law Enforcement Assisted Diversion (LEAD): Program effects on recidivism outcomes

Drug users and dealers frequently cycle through the criminal justice system in what is sometimes referred to as a "revolving door." Arrest, incarceration and prosecution have not deterred this recidivism. Seattle's Law Enforcement Assisted Diversion (LEAD) program was established to divert these individuals to case management and supportive services instead of jail and prosecution. A nonrandomized controlled evaluation was conducted to examine LEAD effects on criminal recidivism (i.e., arrests, criminal charges). The sample included 318 people suspected of low-level drug and prostitution activity in downtown Seattle: 203 received LEAD, and 115 experienced the system-as-usual control condition. Analyses were conducted using logistic generalized estimating equation models over both the shorter term (i.e., six months prior and subsequent to evaluation entry) and longer term (i.e., two years prior to the LEAD start date through July 2014). Compared to controls, LEAD participants had 60% lower odds of arrest during the six months subsequent to evaluation entry; and both a 58% lower odds of arrest and 39% lower odds of being charged with a felony over the longer term. These statistically significant differences in arrests and felony charges for LEAD versus control participants indicated positive effects of the LEAD program on recidivism.